Speech-Language Pathology Management Research Articles

Aligned or misaligned: Are public funding models for speech-language pathology reflecting recommended evidence? An exploratory survey of Australian speech-language pathologists

Government subsidised funding arrangements serve as an essential medium for families to access private speech-language pathology (SLP) services in Australia. This study aimed to investigate whether, from a provider perspective, contemporary public funding models (PFMs) align with best-available scientific evidence for management of children and young persons with swallowing and communication disorders within Australian private-practice settings. This exploratory study was distributed to paediatric speech-language pathologists throughout Australia via an online survey. A total of 121 valid surveys were completed by Australian speech-language pathologists with divergent career experiences. In comparing three familiar PFMs using mixed effects logistic regression models to estimate odds ratios, results indicated that perceived congruence with recommended scientific evidence for SLP management varied across PFMs: the odds of failing to align with scientific evidence was 4.92 times higher for Medicare’s Chronic Disease Management Plan (MBS_CDMP) than for the National Disability Insurance Scheme; and 7.40 times higher in comparison to Medicare’s Helping Children with Autism initiative. This study is the first to report on (in)congruence between PFMs that provide access to independent Australian SLP services for children and young persons and best available scientific evidence to inform clinical practice. Participants identified that: (a) four out of seven contemporary PFMs were unfamiliar to speech-language pathologists; and (b) MBS_CDMP initiative failed to align with the evidence-base for best scientific SLP management.

Public purse, private service: The perceptions of public funding models of Australian independent speech-language pathologists

Purpose Health funding provisions supported by governments are pivotal for families accessing independent speech-language pathology services in Australia. Little is known of the facilitators and barriers that exist for accessing public funding for speech-language pathology services through independent providers. This study aimed to investigate and describe the perceptions of speech-language pathologists in accessing public funding models (PFMs) for children and young persons with communication and swallowing needs within Australian independent practice. Method Semi-structured qualitative interviews were conducted with twenty independent speech-language pathologists who had experience of PFMs in Australia. Digitally recorded interviews were transcribed verbatim and subjected to thematic analysis. Result Data analysis revealed five superordinate and eighteen subordinate themes. The five superordinate themes were: (a) accessibility in securing funding provisions; (b) time as a commodity; (c) incongruence between funding provisions and speech-language pathology evidence; (d) trust as a multifaceted quality; and (e) consequences of PFMs. Conclusion This original and timely research offers perceptive descriptions of the multifaceted facilitators and barriers for families seeking to access public funding for independent speech-language pathology services in Australia. Research findings illuminate challenges for the speech-language pathology profession. Accessibility to funding was identified as a major issue. Research findings suggest that current funding provisions do not align with the dosage required for evidence-based speech-language pathology management. Further, this research has highlighted the need for funding to be equitable, acceptable to stakeholders, and for services to be delivered in an efficient and sustainable manner. Future research is recommended to understand which Australian PFMs: (a) facilitate consumer access to speech-language pathology services; (b) enrich consumer experiences; and (c) align with scientific evidence to promote optimal outcomes.

Speech-Language Pathology Management for Adults with COVID-19 in the Acute Hospital Setting: What Do We Know?

The purpose of this study was to collate and summarize the content covered in published literature describing speech-language pathology management of adult patients with COVID-19 in the acute hospital setting as of February 2022. This review serves as an updated review of the initial recommendations to guide speech-language pathology management for adults with COVID-19 in the acute hospital setting previously provided by Namasivayam-MacDonald and Riquelme in July of 2020. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Extension protocol. We searched for relevant peer-reviewed articles in the following electronic databases: MEDLINE, EMBASE, and CINAHL. The article review process was conducted using Covidence. Our searches yielded a combined total of 3019 unique citations, of which 54 were accepted for full-text review. Thirty-seven of the 54 studies were review articles, recommendations, or opinion pieces. This translates to mostly low levels of evidence (i.e., Levels VI and VII) and a grade of ‘D’ when applying the American Society of Plastic Surgeons grade recommendation scale for evidence-based clinical practice guidelines, meaning there is little or no systematic empirical evidence available. The remaining 17 provided empirical data, which translates to higher levels of evidence and a grade of ‘B’. The empirical data shared in this scoping review provide support for the ongoing role of the SLP in the acute care setting and the impact COVID-19 and its variants have on the underlying systems for communication and swallowing. This document serves as further proof of the need for ongoing research into the clinical presentations of patients with speech-language, cognitive and/or swallowing deficits resulting from COVID-19, as well as into systems of care that will provide the best outcomes in their rehabilitation.

Early Childhood Professionals' Management of Young Children Who Stutter: A Cross-Sectional Study.

Early childhood professionals must accurately identify, refer, and treat children who stutter (CWS) within the scope of their respective roles to ensure each child receives the best possible care. This study aimed to investigate similarities and differences between the practices of speech-language pathologists (SLPs), preschool teachers, and public health nurses when they initially meet a young child reported as stuttering. This cross-sectional study was conducted in Norway. A sample of 342 early childhood professionals (126 preschool teachers, 95 public health nurses, and 121 SLPs) completed an online survey about their management practices with young children reported as stuttering. Descriptive statistics, ordinal regression, and chi-square analyses were used to analyze data. Initial management practices reflected the different roles and competencies of each profession. Less than 15% of SLPs reported they have access to guidelines for working with CWS. This figure was even lower for public health nurses (6.5%) and preschool teachers (12%). The most common recommendations provided to parents by all professions was giving the child time to talk and maintaining eye contact. Each profession's referral for further speech-language pathology management was most commonly influenced by stuttering severity. All professions reported collaborating about management of CWS; the most common reported collaboration was with preschool teachers. Initial management practices varied between professions; however, differences largely reflected the roles and competencies of each profession. The development of guidelines and interdisciplinary seminars is recommended to develop a more complementary approach across professions to improve management practices and ensure young CWS receive the best possible care.

The effects of endovascular clot retrieval and thrombolysis on dysphagia in an Australian quaternary hospital: A retrospective review

To establish incidence rates and patterns of dysphagia following the administration of reperfusion therapies in acute ischaemic stroke management. A retrospective review of 193 patients admitted with acute ischaemic stroke to a quaternary stroke unit in Australia over a three year period was completed. Clinical information extracted included demographics, type (thrombolysis and/or endovascular clot retrieval) and success of reperfusion therapy, and the progression of dysphagia and related factors. Over half of all patients treated with reperfusion therapies presented with dysphagia on initial assessment by speech-language pathology (SLP). The type of reperfusion therapy administered was not significantly correlated with the presence of dysphagia. Dysphagia on initial assessment was significantly correlated with the presence of aphasia on initial assessment, the presence of haemorrhagic transformation, and the success of reperfusion. Increased rates of enteral feeding were also found in this study compared to figures reported in literature. This study identified ongoing high rates of dysphagia amongst this patient population regardless of treatment type, demonstrating the need for ongoing SLP management post stroke. Further research is required in this area to develop an evidence-base for SLPs and the wider medical team and to inform clinical practice guidelines. What is already known on the subject Stroke is one of the leading causes of disability and death internationally. Dysphagia (impaired swallowing), a common sequalae of stroke, is known to contribute to decreased quality of life, increased length of hospital stay and mortality. With advancements in technology, treatments for acute ischaemic stroke (endovascular clot retrieval and thrombolysis) are increasing in popularity. However, limited research exists exploring the impact of these therapies on dysphagia. What this paper adds Despite the advancements in stroke treatment, patients continue to present with high rates of dysphagia. Dysphagia following thrombolysis and/or ECR was found to be significantly correlated to the presence of aphasia, haemorrhagic transformation, and the success of reperfusion (regardless of treatment type). Additionally, increased rates of enteral feeding were found amongst this patient population compared to figures reported in the literature for patients following traditional stroke management. Clinical implications of this study Speech-language pathologists and the wider medical team should consider dysphagia as an ongoing consequence of stroke following reperfusion therapies, with consideration for success of reperfusion and adverse outcomes i.e., haemorrhagic transformation. Further research is required to provide an evidence-base and specific guidelines for the management of dysphagia post reperfusion therapies, including use of enteral feeding.

Speech-Language Pathology Management for Culturally and Linguistically Diverse Patients with COVID-19: A Single-Case Report

Speech-Language Pathology Management for Culturally and Linguistically Diverse Patients with COVID-19: A Single-Case Report

Editors' Foreword: Knowledge and Skill Competencies for Speech-Language Pathology Management of Concussion.

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Speech-Language Pathology Management for Adults With COVID-19 in the Acute Hospital Setting: Initial Recommendations to Guide Clinical Practice

Purpose This document outlines initial recommendations for speech-language pathology management of adult patients with COVID-19 in the acute hospital setting. Method The authors initially developed these recommendations by adapting those developed for physical therapists working with patients with COVID-19 by Thomas et al. (2020). The recommendations then underwent review by 14 speech-language pathologists and rehabilitation-focused academics representing seven countries (Belgium, Brazil, Canada, Ireland, Japan, New Zealand, the United States). The authors consolidated and reviewed the feedback in order to decide what should be included or modified. Applicability to a global audience was intended throughout the document. Results The authors had 100% agreement on the elements of the recommendations that needed to be changed/modified or added. The final document includes recommendations for speech-language pathology workforce planning and preparation, caseload management, service delivery and documentation, as well as recommendations for the selection of appropriate personal protective equipment and augmentative and alternative communication equipment in the acute care hospital setting. Conclusions Speech-language pathologists play a critical role in the assessment, management, and treatment of patients with COVID-19. Several important considerations need to be made in order to meet the needs of this unique patient population. As more is learned about the impact of the virus on swallowing and communication, the role of the speech-language pathologist on interdisciplinary care teams will remain paramount.

The Challenges of Dysphagia Management and Rehabilitation in Two Complex Cases Post Chemical Ingestion Injury.

Dysphagia is common sequelae of chemical ingestion injury, resulting from damage to critical swallowing structures. From a speech-language pathology perspective, this study outlines the physiological deficits in 2 individuals with severe injury (1 woman, acid; 1 man, alkali) and the pattern of dysphagia rehabilitation and recovery. A retrospective chart review of clinical and instrumental assessments was conducted to examine swallow characteristics and speech-language pathology management (compensatory and rehabilitation strategies) at multiple time points. Chemical ingestion injury resulted in severe pharyngeal dysphagia for both participants, warranting speech-language pathology management. Dysphagia was characterized by poor base of tongue mobility and reduced laryngeal excursion. Decreased airway patency and protection, secondary to mucosal sloughing, widespread edema, and structural deficits necessitated tracheostomy. Recovery was complicated by physical alterations of pharyngeal and laryngeal structures (e.g., interarytenoid adhesions) and esophageal strictures. Participant 1 was discharged (Day 135) consuming a texture-modified diet; Participant 2 remained nil by mouth (Day 329). Dysphagia recovery subsequent to chemical ingestion is protracted and complex. Clinical outcomes may be improved through individualized and intensive rehabilitation by speech-language pathologists.

Analysis of speech-language pathology students’ knowledge regarding the use of non-speech oral motor exercises (NSOMEs) in clinical practice: An exploratory pilot study

The use of non-speech oral motor exercises (NSOMEs) in some areas of speech-language pathology (SLP) clinical practice has been debated in the literature. It is unknown if graduating SLP students have a clear understanding regarding appropriate NSOME use. This study aimed to explore SLP students’ knowledge and experiences regarding the use of NSOMEs in the SLP management of (1) dysphagia, (2) tongue thrust swallowing, (3) dysarthria, (4) childhood apraxia of speech (CAS) with a co-occurring oral apraxia, (5) CAS without a co-occurring oral apraxia, (6) articulation disorders, and (7) phonological disorders. An online questionnaire was completed by 51 SLP students in their final year of study. Students reported to have observed or used NSOMEs in each of the seven practice areas. While only five students (9.8%) reported knowledge of NSOME use that was inconsistent with the current evidence-base recommendations for speech production, students lacked clarity regarding appropriate NSOME use in each of the practice areas. The findings from this study suggest that further education regarding NSOME use would be beneficial for SLP students and clinical supervisors.

Cough Reflex Sensitivity Improves with Speech Language Pathology Management of Refractory Chronic Cough

Speech language pathology is an effective management intervention for chronic cough that persists despite medical treatment. The mechanism behind the improvement has not been determined but may include active cough suppression, reduced cough sensitivity or increased cough threshold from reduced laryngeal irritation. Objective measures such as cough reflex sensitivity and cough frequency could be used to determine whether the treatment response was due to reduced underlying cough sensitivity or to more deliberate control exerted by individual patients. The number of treatments required to effect a response was also assessed. The aim of this study was to investigate subjective and objective measures of cough before, during and after speech language pathology treatment for refractory chronic cough and the mechanism underlying the improvement. Adults with chronic cough (n = 17) were assessed before, during and after speech language pathology intervention for refractory chronic cough. The primary outcome measures were capsaicin cough reflex sensitivity, automated cough frequency detection and cough-related quality of life. Following treatment there was a significant improvement in cough related quality of life (Median (IQR) at baseline: 13.5 (6.3) vs. post treatment: 16.9 (4.9), p = 0.002), objective cough frequency (Mean ± SD at baseline: 72.5 ± 55.8 vs. post treatment: 25 ± 27.9 coughs/hr, p = 0.009), and cough reflex sensitivity (Mean ± SD log C5 at baseline: 0.88 ± 0.48 vs. post treatment: 1.65 ± 0.88, p < 0.0001). This is the first study to show that speech language pathology management is an effective intervention for refractory chronic cough and that the mechanism behind the improvement is due to reduced laryngeal irritation which results in decreased cough sensitivity, decreased urge to cough and an increased cough threshold. Speech language pathology may be a useful and sustained treatment for refractory chronic cough. Australian New Zealand Clinical Trials Register, ACTRN12608000284369.

Cough reflex sensitivity improves with speech language pathology management of refractory chronic cough

RationaleSpeech language pathology is an effective management intervention for chronic cough that persists despite medical treatment. The mechanism behind the improvement has not been determined but may include active cough suppression, reduced cough sensitivity or increased cough threshold from reduced laryngeal irritation. Objective measures such as cough reflex sensitivity and cough frequency could be used to determine whether the treatment response was due to reduced underlying cough sensitivity or to more deliberate control exerted by individual patients. The number of treatments required to effect a response was also assessed.ObjectiveThe aim of this study was to investigate subjective and objective measures of cough before, during and after speech language pathology treatment for refractory chronic cough and the mechanism underlying the improvement.MethodsAdults with chronic cough (n = 17) were assessed before, during and after speech language pathology intervention for refractory chronic cough. The primary outcome measures were capsaicin cough reflex sensitivity, automated cough frequency detection and cough-related quality of life.ResultsFollowing treatment there was a significant improvement in cough related quality of life (Median (IQR) at baseline: 13.5 (6.3) vs. post treatment: 16.9 (4.9), p = 0.002), objective cough frequency (Mean ± SD at baseline: 72.5 ± 55.8 vs. post treatment: 25 ± 27.9 coughs/hr, p = 0.009), and cough reflex sensitivity (Mean ± SD log C5 at baseline: 0.88 ± 0.48 vs. post treatment: 1.65 ± 0.88, p < 0.0001).ConclusionsThis is the first study to show that speech language pathology management is an effective intervention for refractory chronic cough and that the mechanism behind the improvement is due to reduced laryngeal irritation which results in decreased cough sensitivity, decreased urge to cough and an increased cough threshold. Speech language pathology may be a useful and sustained treatment for refractory chronic cough.Trial RegistrationAustralian New Zealand Clinical Trials Register, ACTRN12608000284369.

Speech-Language Pathology Management of TBI in School-Aged Children

Speech-Language Pathology Management of TBI in School-Aged Children

Speech-Language Pathology Management of TBI in School-Aged Children

Speech-Language Pathology Management of TBI in School-Aged Children